Medicare AdvantageCoverageMedium impact
MA07.006d, Fecal Microbiota Transplantation (FMT)
Independence Blue Cross·Gastroenterology, Infectious Disease·Medical Policy
Effective date
May 28, 2025
We identified it
Jun 19, 2026
Summary
Policy MA07.006d regarding Fecal Microbiota Transplantation (FMT) has been reissued effective 05/28/2025. The previous version was removed on 09/09/2025. The billing team must obtain and review the complete updated policy text to identify specific coverage criteria, billing code requirements, prior authorization mandates, and any changes to reimbursement or documentation standards for FMT procedures.
Action Required
By 09/30/2025: Billing team must obtain the complete full-text policy document for MA07.006d from the source URL (https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=09&FilterField2=MPSiteActivityLogYear&FilterValue2=2025). Review all sections to identify: (1) covered FMT CPT/HCPCS codes, (2) prior authorization requirements, (3) medical necessity documentation standards, (4) diagnosis code limitations (ICD-10), and (5) any billing modifiers or restrictions. Update billing system rules, encounter forms, and provider guidelines accordingly. Notify gastroenterology and infectious disease providers of any changes. Claims submitted without compliance to the reissued policy may be denied.